Jill Sonke is the director of the Center for Arts in Medicine at the University of Florida in Gainesville. The center advances the field of arts in health through education, research, and outreach. It is also includes a creative arts therapy program that takes veteran’s care in new directions by providing treatment remotely through a telehealth program. We spoke with Jill (remotely) to learn more about telehealth and the center’s partnership with the nearby Malcom Randal Veterans Administration Hospital.

NEA: What exactly is a telehealth program? How does it work?

JILL SONKE: It starts with an in-person appointment at the local-to-you V.A. hospital. Within that appointment, we find out whether the patient has a computer at home that they would like to use or whether they need a device which we can provide to them. Then we provide access to our very secure internal system to connect to the patient. So it’s very much like using Skype. 

NEA: What is your relationship with the Malcom Randal Veterans Administration (V.A.) Hospital?

SONKE: We’ve partnered in many ways over the years and have always had programs going on. Now, we are in year three of partnering with the hospital’s telehealth initiative. Our V.A. medical system has the largest telehealth program in the country, serving more patients via telehealth than any other region in the United States.

Dr. Charles Levy is the chief of Physical Medicine and Rehabilitation at the V.A. and heads up their telehealth program. Also, he is a renowned banjoist who has played music in our clinical programs for about 20 years and serves on our advisory board. As his telehealth initiative grew, he became interested in how we could engage the arts and use the telehealth platform to provide creative arts therapy services for homebound and rural veterans. 

We got a grant through the Office of Rural Health within the V.A. system to implement a creative arts therapies program within the Rural Veterans Telehealth Initiative here. It’s been extremely successful. We have an art therapist and a dance/movement therapist who work on that telehealth platform. Our creative arts therapists have a couple of cameras, so the veterans can have a view of artwork on a surface and of the therapists. The veteran at home is using a single camera and adjusting it to show their artwork or pulling back if they’re doing movement or talking into the camera. The two therapists together provide 40 hours of services a week. It’s really proved to be an important and effective intervention for those homebound veterans. 

We use a Skype-like platform called Jabber. We had to develop pre- and post-clinical assessments and our creative arts therapists had to go through all the necessary trainings and screenings, but we jumped right into it. Our creative arts therapists, Heather Spooner and Jenny Lee, have developed fantastic protocols for how you engage in the creative arts therapies via telehealth. And through clinical assessments with patients, we’re looking at the impacts and outcomes.

NEA: What have you’ve learned so far?

SONKE: We have really been surprised at how quickly the veterans embraced the program and adapted to the technology. We had to learn to adapt processes that we would normally facilitate in person to the telehealth program and have learned a number of techniques for this over the past few years. For those veterans who have participated it has been truly life changing. 

NEA: Are there other issues that have surfaced as you’ve been working with this population?

SONKE: One of the major things that I hear from Jenny and Heather is [a concern about] privacy. If you’re in a face-to-face clinical session, the therapist has control of the physical environment. When the veteran is in their home, there are often other people around. They’re dealing with people walking through the room. So managing and creating a sense of privacy and safety is different. But the therapists are developing great ways of addressing that with people and helping them set up a situation in which they’re comfortable working with the therapist.

One of the other issues is connectivity from the veteran’s home. The level of bandwidth varies, and so, even widely-used interfaces are not perfect. Certainly, as technologies become more reliable, that’ll make the program easier. At the same time, it doesn’t necessarily cause the level of frustration that you might expect. If there’s a glitch in the system, they just reconnect and keep moving on.

NEA: How do you see the program developing, aside from having it reach more communities?

SONKE:  We’re interested in branching out into music therapy; it’s a modality that we haven’t investigated. We’re also interested in seeing more people, so that we can do better research with significant numbers of people. And, yes, technologies are always changing and we always want to increase the ease. 

NEA: Aside from privacy, how else does the digital interface impact the interaction, in either a positive or negative way? 

SONKE: The best part is that it simply does reach them and gets to people who wouldn’t have access otherwise. Even if patients had an appointment scheduled, in many cases it’s just too much. There are barriers to travel, barriers to access. So the very best thing is that these folks are getting the services. 

Since our launch, the NEA and its partners in Creative Forces: NEA Military Healing Arts Network have been busy! Creative art therapists are joining the military medical centers announced last fall and research projects are underway. Stay tuned for a March 28 announcement on additional clinical sites that will be joining the network and other news!